MEDICARE: PROF. JEFFREY LEE WIHEBRINK I LMHC, MAC, SAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	39000043	IN

General Provider Information

NPI Number	:	1124166533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. JEFFREY LEE WIHEBRINK I LMHC, MAC, SAP

Provider Business Mailing Address
First Line	:	4660 W JEFFERSON BLVD
Second Line	:	SUITE 200
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-6845
Country	:	US
Telephone Number	:	260-432-9916
Fax Number	:	260-960-9349

Provider Business Practice Location Address
First Line	:	4660 W JEFFERSON BLVD
Second Line	:	SUITE 200
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-6845
Country	:	US
Telephone Number	:	260-432-9916
Fax Number	:	260-960-9349

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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